A reduction in hepatic venous pressure gradient of 20% or more of baseline or to 12 mmHg or less is associated with a reduced risk of first variceal bleeding.
Dr Juan Carlos Garcia-Pagan and colleagues evaluated whether this protective effect is maintained in the long term.
The research team also assessed if it extends to other portal hypertension complications.
The team evaluated 71 cirrhotic patients with esophageal varices and without previous variceal bleeding.
The patients were entered into a program of prophylactic pharmacological therapy and were followed for up to 8 years.
All had 2 separate hepatic venous pressure gradient measurements.
The measurements were undertaken at baseline and after pharmacological therapy with propranolol and isosorbide mononitrate.
| Responders had a higher 8-year cumulative probability of being free of first variceal bleeding|
|American Journal of Gastroenterology|
Responders were defined as having a reduction in hepatic venous pressure gradient of 20% or more of baseline or to 12 mmHg.
The team reported that 46 patients were nonresponders and 25 were responders.
The team found that 8-year cumulative probability of being free of first variceal bleeding was higher in responders than in nonresponders.
The lack of hemodynamic response and low platelet count were the only independent predictors of first variceal bleeding.
The researchers also noted that this reduction was independently associated with a decreased risk of spontaneous bacterial peritonitis or bacteremia.
No significant differences in the development of ascites, hepatic encephalopathy, or survival were observed.
Dr Garcia-Pagan's team concluded, “The hemodynamic response in cirrhotic patients is associated with a sustained reduction in the risk of first variceal bleeding over a long-term follow-up.”
“Reduction of hepatic venous pressure gradient also correlate with a reduced risk of spontaneous bacterial peritonitis or bacteremia.”